Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Genesis HealthCare, Kennett Square, Pennsylvania, USA.
J Am Geriatr Soc. 2020 Oct;68(10):2167-2173. doi: 10.1111/jgs.16752. Epub 2020 Aug 21.
To identify county and facility factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in skilled nursing facilities (SNFs).
Cross-sectional study linking county SARS-CoV-2 prevalence data, administrative data, state reports of SNF outbreaks, and data from Genesis HealthCare, a large multistate provider of post-acute and long-term care. State data are reported as of April 21, 2020; Genesis data are reported as of May 4, 2020.
The Genesis sample consisted of 341 SNFs in 25 states, including a subset of 64 SNFs that underwent universal testing of all residents. The non-Genesis sample included all other SNFs (n = 3,016) in the 12 states where Genesis operates that released the names of SNFs with outbreaks.
For Genesis and non-Genesis SNFs: any outbreak (one or more residents testing positive for SARS-CoV-2). For Genesis SNFs only: number of confirmed cases, SNF case fatality rate, and prevalence after universal testing.
One hundred eighteen (34.6%) Genesis SNFs and 640 (21.2%) non-Genesis SNFs had outbreaks. A difference in county prevalence of 1,000 cases per 100,000 (1%) was associated with a 33.6 percentage point (95% confidence interval (CI) = 9.6-57.7 percentage point; P = .008) difference in the probability of an outbreak for Genesis and non-Genesis SNFs combined, and a difference of 12.5 cases per facility (95% CI = 4.4-20.8 cases; P = .003) for Genesis SNFs. A 10-bed difference in facility size was associated with a 0.9 percentage point (95% CI = 0.6-1.2 percentage point; P < .001) difference in the probability of outbreak. We found no consistent relationship between Nursing Home Compare Five-Star ratings or past infection control deficiency citations and probability or severity of outbreak.
Larger SNFs and SNFs in areas of high SARS-CoV-2 prevalence are at high risk for outbreaks and must have access to universal testing to detect cases, implement mitigation strategies, and prevent further potentially avoidable cases and related complications. J Am Geriatr Soc 68:2167-2173, 2020.
确定与熟练护理设施（SNF）中严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）爆发相关的县和设施因素。
将县 SARS-CoV-2 流行数据、行政数据、州报告的 SNF 爆发情况以及来自 Genesis HealthCare 的数据联系起来的横断面研究，这是一家提供后期急性和长期护理的大型多州提供商。州数据截至 2020 年 4 月 21 日报告；Genesis 数据截至 2020 年 5 月 4 日报告。
Genesis 样本包括 25 个州的 341 个 SNF，其中包括对所有居民进行普遍检测的 64 个 SNF 的子集。非 Genesis 样本包括在 Genesis 运营的 12 个州中发布爆发 SNF 名称的所有其他 SNF（n=3016）。
对于 Genesis 和非 Genesis SNF：任何爆发（一个或多个居民的 SARS-CoV-2 检测呈阳性）。仅对于 Genesis SNF：确诊病例数、SNF 病死率和普遍检测后的流行率。
118 个（34.6%）Genesis SNF 和 640 个（21.2%）非 Genesis SNF 爆发。县流行率相差 1000 例/每 100000 人（1%），与 Genesis 和非 Genesis SNF 联合爆发的概率相差 33.6 个百分点（95%置信区间（CI）=9.6-57.7 个百分点；P=0.008），而 Genesis SNF 则相差 12.5 例/设施（95%CI=4.4-20.8 例；P=0.003）。设施规模相差 10 张床位与爆发概率相差 0.9 个百分点（95%CI=0.6-1.2 个百分点；P<0.001）有关。我们没有发现疗养院比较五星评级或过去感染控制缺陷引文与爆发的可能性或严重程度之间的一致关系。
较大的 SNF 和 SARS-CoV-2 流行地区的 SNF 爆发风险较高，必须能够进行普遍检测以发现病例，实施缓解策略，并防止进一步发生潜在可避免的病例和相关并发症。美国老年医学会 68：2167-2173，2020。
